1. What is EQAS?
EQAS stands for External Quality Assurance Scheme and is a quality assessment system for diagnostic laboratories to check the accuracy of their testing methods by comparing them against standard references and peer laboratories. The National Cancer Grid External Quality Assurance Scheme (NCG EQAS) is a national quality assurance program established to improve the quality, consistency, and reliability of cancer histopathology services across India.
Developed under the aegis of the National Cancer Grid and coordinated by Tata Memorial Hospital, EQAS supports participating laboratories through structured quality assessment exercises, expert review, educational feedback, and performance benchmarking on all aspect of histopathology reporting in cancer. The initiative aligns with NCG's broader vision of delivering uniform, evidence-based cancer care irrespective of geography or resource setting.
2. Why is EQAS Important?
In the era of precision medicine variability in histopathology reports and biomarker testing can directly influence patient management and outcomes.
EQAS helps reduce this variability by promoting standardized testing protocols by advocating use of harmonized reporting practices, and suggestions for continuous quality improvement across participating laboratories. By providing objective performance assessment and expert feedback, the program strengthens confidence in pathology results, and ultimately contributes to better patient care.
The Aim of NCGEQAS is “one practice for all”. We seek to align most laboratories to follow good pathology practices and improve standards of cancer care throughout the country.
3. What Are the Objectives of EQAS?
The EQAS program aims to:
- Standardize histopathology and oncopathology practices across participating laboratories.
- Improve the accuracy, reproducibility, and reliability of pathology testing.
- Enable continuous learning through educational feedback.
- Strengthen quality assurance infrastructure across India's cancer care ecosystem.
- Support evidence-based clinical decision-making through high-quality pathology services.
4. Key Features / How It Works
NCGEQAS has three modules IHC EQAS, H&E diagnosis and tissue quality module. It essentially circulates a set of cases to participants who then test it using their in house protocols and then return the cases back to NCGEQAS for interpretation. The EQAAS team then compares their results with gold standard and gives a pass rate to the participating laboratory. This program is free for centers of NCG and others are charged a nominal fee.
Key features include:
- Comprehensive EQA report: Each report contains information on how centre as performed and a Run report that illustrates performance of peers.
- Multiple quality assessment modules: Including tissue processing, diagnostic histopathology, minimum dataset reporting (MDSR), and immunohistochemistry (IHC) across multiple biomarker panels.
- Digital participant portal: Laboratories register online, access module schedules, submit protocols and results, and download reports through a secure web platform.
- Periodic assessment cycles: Participating laboratories receive standardized cases or slides, perform testing using routine laboratory workflows, and submit their interpretations within defined timelines.
- Benchmarking and continuous improvement: Repeat participation enables laboratories to monitor trends, identify gaps, and demonstrate sustained quality enhancement over time. We have seen a 30% improvement in laboratory pass rate in centers who have consistently participated.
5. What Are the Benefits of EQAS?
Participating Laboratories
- Independent assessment of diagnostic performance.
- Benchmarking against national standards and peer laboratories.
- Expert feedback for continuous quality improvement.
- Standardized testing and reporting practices.
- Educational learning through every assessment cycle.
Healthcare Institutions
- Improved laboratory quality and diagnostic consistency.
- Greater confidence in pathology reports supporting multidisciplinary cancer care.
- Strengthened quality assurance and accreditation readiness.
Patients
- More accurate and reproducible pathology diagnoses.
- Greater consistency in biomarker testing and cancer reporting.
- Better quality of cancer care regardless of where testing is performed.
National Quality Initiatives
- Supports NCG's mission of uniform standards of cancer care across India.
- Encourages adoption of evidence-based pathology practices.
- Builds a national network committed to continuous quality improvement.
- Creates valuable benchmarking data to guide future quality initiatives and capacity building.
6. Current Progress / Achievements
The NCG EQAS program has evolved into one of India's major national quality initiatives for cancer pathology. At present, NCGEQAS boasts of 400 participant centres, 385 of who have come on board the new application. It has completed 8 annual runs of tissue processing, 33 runs of Immunohistochemistry module, and 29 combined annual runs of digital pathology comprising of Minimum data set reporting and Diagnostic Histopathology.
7. Future Roadmap / Next Steps
NCG EQAS will continue expanding its role as a national quality assurance platform by:
- Increasing participation across pathology laboratories throughout India.
- Expanding assessment modules to additional pathology subspecialties and emerging biomarkers.
- Developing longitudinal performance tracking.
- Acquiring NABL National Accreditation Board for Testing and Calibration Laboratories accreditation further helping better recognition in quality testing.
- Enhancing integration with other NCG digital programs to create a connected ecosystem for pathology quality, education, and continuous improvement.
